South Florida Sun-Sentinel Palm Beach (Sunday)
Too much of medication for Graves’ disease has ill effects
Q: I feel like I am walking a tightrope between hyper- and hypothyroidism. I was diagnosed with Graves’disease because my thyroid went into overdrive. I lost a lot of weight, developed a tremor and I had to take metoprolol for my rapid heart rate.
My thyroid doctor prescribed methimazole to calm the thyroid down. Now, I am gaining weight and my heart rate is slow. I have a hard time getting going in the morning, not to mention I can fall asleep for a midday nap given half a chance. Could the medicine be suppressing my thyroid too much? A: Graves’ disease is an autoimmune condition in which the thyroid gland produces too much hormone. Symptoms can include palpitations, nervousness, fatigue, elevated blood pressure and heart rate, hair thinning, weight loss and insomnia.
Methimazole interferes with the production of T4 and T3 thyroid hormones. Too much medication could result in inadequate thyroid hormone. Weight gain, slow heart rate and fatigue are typical of hypothyroidism.
Ask your physician about testing your thyroid hormone levels. Your dose of methimazole might need adjustment.
Q: Somehow, I never contracted COVID-19, but I did get all the shots and boosters. Since receiving my first vaccine, the cold sores that I used to get on my lips two to four times a year for the past 30 years have completely vanished.
So have my plantar
One reader with Graves’ disease experienced a hard time getting going in the morning due to fatigue.
warts, which I’ve had for even longer. They resisted multiple treatments, including surgical removal. Now they are gone. Is my experience unique? A: Shortly after people started getting COVID-19 vaccinations, some began reporting that they’d had long-lasting warts disappear. There are some case reports in the medical literature (JAAD Case Reports, January 2023).
Another reader had a different experience: “I just got over COVID, for which I took Paxlovid for three days. I now see that all my warts are gone!
“That is the only positive thing that came out of the illness. I had two vaccines and a booster in the past year, which didn’t faze the warts.”
But we also discovered a number of case reports that COVID-19 vaccination had reactivated herpes simplex eye infections (Ocular Immunology and Inflammation, July 2022).
Q: I was taking high doses of ibuprofen for spine and leg pain. My blood pressure was high, so my doctor prescribed BP medications. He added one after another without any obvious improvement. We
were both frustrated.
I finally tried going without ibuprofen, and my BP fell to normal. I started breaking my BP pills in half, and my BP stayed low, even under stressful conditions.
I recommend that if you have stubbornly high blood pressure and take ibuprofen, stop it for a few weeks and check your BP.
You might have heard that the increased blood pressure due to using this type of pain reliever is no big deal. I am proof it can be impressive.
If you take a lot of ibuprofen and have high BP, don’t take more BP meds. Instead, stop the pain reliever for a few weeks and check your numbers.
A: Thank you for sharing your story. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as celecoxib, diclofenac, ibuprofen, naproxen and meloxicam all can raise blood pressure (BMC Cardiovascular Disorders, Oct. 24, 2012). Some people, like you, may be sensitive to this effect.
In their column, Joe and Teresa Graedon answer letters from readers. Send questions to them via www. peoplespharmacy.com.
Q: My child moves around a lot at bedtime and has trouble falling asleep.
She describes“bugs” on her legs. As someone who was diagnosed with restless legs syndrome, I am wondering if children can develop restless legs syndrome, too?
A: Yes, children can have restless legs syndrome.
You also may hear it called Willis-Ekbom disease, based on the names of the physicians who first described this condition.
Just like adults, children can have sensations in their legs that makes it hard for them to sleep. If the sensation happens regularly, they may have restless legs syndrome, which is a sleep disorder.
Restless legs syndrome can occur in about 2% of school-aged children. It also can run in families. Children with symptoms may have a parent who has restless legs syndrome.
The syndrome does not lead to other health problems in children. Treatments are available that can reduce or eliminate restless legs syndrome.
It can be challenging to diagnose children with restless legs syndrome, which is characterized by an unpleasant or uncomfortable urge to move their legs. Some describe it as a crawling, pulling or burning sensation in the thighs, calves or feet. Children may describe “bugs” or use other such descriptors.
The sensation is temporarily relieved when they get up and move, or when they shift or stretch their legs. Children also can have “growing pains,” which typically wax and wane, and are not associated with the need for movement.
Symptoms of restless legs syndrome typically begin at night after a person has been sitting or lying down for some time. These symptoms can occur during the day, too, when a person is sitting, but they typically are worse at night. Children may have these feelings while sitting in a car or classroom. In kids, symptoms can start as early as 5 to 6 years old.
Many people have mild leg twitches as they drift off to sleep. These movements, called “hypnic starts,” are a normal part of falling asleep. They are not associated with restless legs syndrome. Restless legs syndrome is much more uncomfortable.
Sometimes muscle and ligament strain can be misinterpreted as restless legs syndrome. Usually, however, a strain is relieved by rest; whereas, the symptoms of restless legs syndrome worsen when limbs are kept still.
Sleep studies are not necessary unless children cannot accurately describe their symptoms. Based on how old they are developmentally, it can be difficult for them to describe the feelings in their legs, so speak with a health care provider about options.
Treatment focuses on relieving symptoms. Taking a warm bath, massaging the legs, or applying warm or cool packs can calm symptoms of restless legs syndrome. Stretching, followed by regular moderate exercise and establishing good sleep habits also can make a difference. Caffeine, alcohol or tobacco consumption can trigger or worsen symptoms.
Research shows that too little iron in a person’s diet can contribute to restless legs syndrome. Some young children or toddlers have a high consumption of cow’s milk, which can lead to low iron. You may want to speak to your pediatrician about checking their blood iron level.
If the blood iron level is low, eating more iron-rich foods can help. Examples include red meat; dark green leafy vegetables; beans; and iron-fortified breads, cereals and pastas. Your provider also might suggest iron supplements, which is usually the first choice to treat children.
No medications have been approved by the
Food and Drug Administration for children with restless legs syndrome. Certain medications may be considered by a sleep medicine physician if children have not responded to other measures.
— Julie Baughn, M.D., Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
Mayo Clinic Q&A is an educational resource and doesn’t replace regular medical care. Email a question to MayoClinicQ&A@ mayo.edu.